| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,933 |
1,903 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,165 |
2,136 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,485 |
2,439 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
220 |
111 |
$23K |
| D0272 |
Bitewings - two radiographic images |
714 |
697 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
368 |
344 |
$14K |
| D1110 |
Prophylaxis - adult |
206 |
204 |
$12K |
| D1351 |
Sealant - per tooth |
357 |
88 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
60 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
40 |
$7K |
| D0330 |
Panoramic radiographic image |
78 |
78 |
$5K |
| D1354 |
|
54 |
17 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
199 |
182 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
54 |
52 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
34 |
$1K |
| D2940 |
|
23 |
15 |
$1K |
| D0274 |
Bitewings - four radiographic images |
17 |
17 |
$691.90 |
| D0230 |
Intraoral - periapical each additional radiographic image |
48 |
14 |
$363.00 |
| D1999 |
|
354 |
339 |
$0.00 |